The Evolving Landscape of Cell Transplant Therapy in Cancer Care
By Zandra Rivera, DNP, APRN, ANP-BC, BMTCN®
Each year more than 50,000 stem cell transplantations (https://www.who.int/transplantation/hsctx/en/) are completed worldwide. The stimulation, harvesting, and therapeutic use of patient and donor cells has evolved as a treatment for diverse cancer diagnoses, and specially trained nurses are at the heart of the clinical trials and care delivery to propel cell transplant therapy across practice settings.
A History of Transplantation
Transplant therapy has changed significantly since it was first introduced nearly 80 years ago (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222417/). What started as bone marrow transplantation (BMT), named for the removal of cells through bone marrow aspiration, later transitioned to hematopoietic stem cell transplantation (HSCT), referring to the pluripotent stem cells from which all marrow cells evolve and are harvested through apheresis.
In the past decade, cancer care has further expanded to include immune effector cell therapy, the method of collecting and programming T cells, such as chimeric antigen receptor (CAR) cells, and reinfusing them to create an immune response against underlying malignancies. CAR T-cell therapy (https://www.cancer.gov/publications/dictionaries/cancer-terms/def/car-t-cell-therapy) has evolved rapidly and now has U.S. Food and Drug Administration (FDA) approvals for hematologic malignancies and investigational uses in diverse tumor types.
Types of Transplantations
Autologous transplantations, in which the patient donates and receives their own cells, support bone marrow recovery after high-dose chemotherapy. They’ve been used for everything from solid tumors (e.g., brain, testicular, and breast cancers) to hematologic malignancies (e.g., leukemia, lymphoma, multiple myeloma).
Allogeneic transplantations, in which the cells come from a related or unrelated donor, replace the source of malignant cells in the marrow as well as diseased cells for some noncancerous blood and autoimmune conditions.
A Transplant Nurse’s Significant Role
Transplant nurses are fundamental to the safety and evidence-based care of patients with cancer. However, they have a unique role compared to other hematology or solid tumor specialists.
Unlike nurse colleagues who specialize in a specific malignancy like leukemia or breast cancer, transplant nurses are specialists in a treatment type that may be applied to diverse cancer diagnoses (https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/stem-cell-transplant/types-of-transplants.html). Furthermore, transplant nurses are prepared to manage transplant-related toxicities (https://pubmed.ncbi.nlm.nih.gov/15328824) like graft-versus-host disease (https://my.clevelandclinic.org/health/diseases/10255-graft-vs-host-disease-an-overview-in-bone-marrow-transplant).
Pursuing a Career in Transplant Nursing
Transplant nursing is a specialty field without specific academic programs. Therefore, specialized training occurs in the context of clinical practice. If you’re interested in pursuing a career in transplant nursing, look for local hospitals or treatment centers that are certified to perform HSCT (http://accredited.factwebsite.org/) or CAR T-cell infusions. (https://www.bmtinfonet.org/transplant-article/medical-centers-offering-car-t-cell-therapy)
ONS offers free continuing education (https://www.ons.org/develop-your-career/professional-development/free-ncpd-activities) opportunities to learn more about current and emerging trends in transplant and cellular therapy.
After two years of clinical practice, 2,000 hours of transplant nursing experience, and completion of at least 10 contact hours, nurses can further solidify their BMT expertise in the field with a BMTCN® certification (https://www.oncc.org/certifications/blood-marrow-transplant-certified-nurse-bmtcn) through the Oncology Nursing Certification Corporation.